Appeals and Grievance Analyst

Job Summary

A company is looking for an Appeals and Grievance Analyst.

Key Responsibilities

• Manage and coordinate member appeals and grievances in compliance with regulatory requirements
• Prepare cases for review and discussion at the Member Appeals Committee and provide documentation to members regarding appeal outcomes
• Consult with subject matter experts and gather necessary information for case resolution

Required Qualifications

• Associate's Degree or equivalent experience in health care, conflict resolution, or related field (Bachelor's preferred)
• 2-4 years of experience in customer service or member services within health care or insurance (2 years in Appeals and Grievance preferred)
• Knowledge of health care benefits and regulatory requirements preferred
• Proficiency in using computer systems and applications
• Ability to work independently and collaboratively while managing multiple tasks and priorities